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dc.contributor.authorThingstad, Pernille
dc.date.accessioned2016-01-14T07:56:28Z
dc.date.available2016-01-14T07:56:28Z
dc.date.issued2015
dc.identifier.isbn978-82-326-1215-4
dc.identifier.issn1503-8181
dc.identifier.urihttp://hdl.handle.net/11250/2373736
dc.description.abstractAbstract Hip fractures are associated with severe decline in gait function and can represent a dramatic change in life situation for older people. At present, knowledge is scarce on type, timing and organisation of interventions to maximise gait recovery after hip fractures, and few intervention studies have included measures of gait characteristics beyond gait speed. The overall aim of this thesis is to identify and describe relevant gait characteristics in older community-dwelling people who have sustained a hip fracture, and to provide a better base of knowledge for the development of more targeted interventions to maximise gait recovery after hip fracture. This thesis is based on four papers, the first two with a methodological approach and the last two with a clinical approach. Paper I aims to examine to which extent spatial and temporal gait characteristics are comparable when analysed with different software-products, while paper two aims to identify the most relevant gait characteristics to describe gait recovery following hip fracture. Paper III is an evaluation of the long term effect of early multidisciplinary and multicomponent hospital intervention on gait, while paper IV is a protocol paper describing the rationale for a municipality based exercise trial targeting gait control, including also data on inclusion and attrition rate. Data were collected through two randomised controlled clinical trials including a total of 620 community-dwelling older adults with hip fracture: i) The Trondheim Hip fracture Trial comparing comprehensive geriatric care with conventional orthopaedic care, and ii) the EvaHip trial, aiming to evaluate the added effect of a home based exercise programme delivered four months following the fracture, compared with routine practice in the municipality. Data on spatial and temporal gait characteristics were collected using an instrumented walkway (GAITRite®) four and 12 months following the fracture. Results showed high level of agreement for gait variables between software-products. Four gait domains; Pace/rhythm, postural control, variability and asymmetry, and four corresponding key gait variables; double support time, walk ratio, step velocity variability and single support asymmetry were identified using a factor analysis approach. Gait characteristics following hip fracture demonstrated reduced gait control, increased fall risk and high energy costs of walking. Significant group differences in favour of participants who had received comprehensive geriatric care in the early preoperative and postoperative stages were found for double support, walk ratio and asymmetry. Inclusion and attrition rate reported in the protocol paper indicated that a relatively high proportion of community-dwelling older adults were able to participate in an exercise programmes when performed in a home setting, but that participants who refused to participate had lower pre-fracture cognitive function compared to those who were randomised. Results from the hospital study showed that a relatively short multicomponent intervention improved gait outcome as long as one year following the fracture and suggest that targeting the vulnerability of these patients in the early stage is important for long-term gait outcomes. Inclusion an attrition rate reported in the protocol article indicates that reduced cognitive function is a barrier for participation in municipality based rehabilitation programmes. Further work should aim to develop integrated care pathways covering both hospital and municipality rehabilitation and to develop better tailored and targeted interventions to maximise gait recovery. Norsk sammendrag Gangfunksjon etter hoftebrudd Identifisering av gangkarakteristika og intervensjoner for å optimalisere gangfunksjon - I Norge er det vel 9000 hoftebrudd hvert år. Årlige kostnader er 4.5 milliard og det vil være en stor samfunnsøkonomisk gevinst knyttet til bedring av behandlings- og rehabiliteringstilbudet for denne gruppen. Hoftebrudd rammer i all hovedsak eldre. Et hoftebrudd representerer ofte en dramatisk endring i livssituasjon, tap av selvstendighet i daglige funksjoner og økt hjelpebehov. Få gjenvinner samme gangfunksjon som før bruddet, flertallet blir avhengig av ganghjelpemidler og risikoen for nye fall er betydelig. Tapet av funksjon er ofte større enn hva skaden alene skulle tilsi, og dette forklares gjerne med at eldre med hoftebrudd representerer en særlig sårbar gruppe pasienter. I dag er det begrenset kunnskap om hvilke type behandling og rehabilitering som kan bidra til å redusere funksjonstapet og optimalisere gangfunksjon hos denne sårbare pasientgruppen. Avhandlingen er basert på gangdata fra totalt 620 hoftebrudds pasienter, inkludert i to ulike klinisk randomiserte studier, en med fokus på sykehusbehandling og en med fokus på fysioterapi i kommunal regi. Fire ulike gangkarakteristika: dobbel standfase, gangratio, variabilitet og asymmetri ble identifisert ved hjelp av faktoranalyse, og blir foreslått som gode indikatorer på gangkvalitet etter et hoftebrudd. Resultatene viste at pasienter som hadde fått behandling på en geriatrisk sengepost i forbindelse med hoftebruddet hadde bedre gangkvalitet et år etter bruddet, rapporterte bedre mobilitet og det var flere som fremdeles var i stand til å gå et år etter, sammenlignet med pasienter som hadde fått standard behandling på en ortopedisk sengepost. Treningsstudien viste at en stor andel av eldre som har hatt hoftebrudd er i stand til å gjennomføre et relativt intensivt treningsprogram når det foregår i hjemmet under veileding av fysioterapeut. Det ser imidlertid ut som kognitiv svikt kan være en barriere for deltagelse, noe som indikerer at dette er en gruppe som krever ekstra oppmerksomhet. Disse funnene indikerer at mange eldre med hoftebrudd i dag ikke får et optimalt tilbud med tanke på å gjenvinne gangfunksjon, og at det er et potensiale for å bedre behandlings og rehabiliteringstilbudet ved å innføre modeller basert på geriatrisk utredning og behandling.nb_NO
dc.language.isoengnb_NO
dc.publisherNTNUnb_NO
dc.relation.ispartofseriesDoctoral thesis at NTNU;2015:2015:279
dc.relation.haspartPaper 1: Egerton, Thorlene; Thingstad, Pernille; Helbostad, Jorunn L.. Comparison of programs for determining temporal-spatial gait variables from instrumented walkway data: PKmas versus GAITRite. BMC Research Notes 2014 ;Volum 7.(1). http://doi.org/10.1186/1756-0500-7-542
dc.relation.haspartPaper 2: Thingstad P, Egerton T, lhlen E.F, Moe-Nilssen R, Helbostad J.L. Identification of gait domains and key gait variables following hip fracture. BMC geriatrics; https://doi.org/10.1186/s12877-015-0147-4
dc.relation.haspartPaper 3: Thingstad P, Taraldsen K., Saltvedt I., Sletvold O.; Vereijken B.; Lamb S.E., Helbostad J.L. The long term effect of Comprehensive Geriatric Care on gait after hip fracture: The Trondheim Hip Fracture Trial - a randomized controlled trial. Osteoporosis International; This is a post-peer-review, pre-copyedit version of an article published in Osteoporosis International. The final authenticated version is available online at: https://doi.org/10.1007/s00198-015-3313-9
dc.relation.haspartPaper 4: Thingstad, Pernille; Taraldsen, Kristin; Hagen, Gunhild; Sand, Sylvi; Saltvedt, Ingvild; Sletvold, Olav; Helbostad, Jorunn L.. Effectiveness of Task Specific Gait and Balance Exercise 4 Months After Hip Fracture: Protocol of a Randomized Controlled Trial - The Eva-Hip Study. Physiotherapy Research International 2015 ;Volum 20.(2) s. 87-99© 2014 John Wiley & Sons, Ltd. https://doi.org/10.1002/pri.1599
dc.titleGait following Hip Fracture: Identification of key characteristics of gait and interventions to maximise gait recoverynb_NO
dc.typeDoctoral thesisnb_NO


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